Dulaglutide
Incretin mimetics
Overview
Dulaglutide, sold under the brand name Trulicity, is a medication used for the treatment of type 2 diabetes in combination with diet and exercise. This medication is often prescribed for adults and children age 10 and older with type 2 diabetes . It is utilized alongside diet and exercise in order to improve blood sugar. It is also approved in the United States for the reduction of major adverse cardiovascular events such as death, heart attack, or stroke in adults with type 2 diabetes who have established cardiovascular disease or multiple cardiovascular risk factors. It is not yet known if it is beneficial, safe, or effective in lowering blood sugar in children under 10 years of age.
Trulicity is taken by giving an injection once a week under the skin of your stomach, thigh, or upper arm. The medication is a prescription that comes in the form of a pre-filled single-dose pen in 0.75mg, 1.5mg, 3mg, or 4.5mg per 5mg injection. You are able to take the dosage at any time during the day of administration with/without food eaten. The most common side effects upon administration are nausea, diarrhea, vomiting, abdominal pain, and decreased appetite.
Dulaglutide injection is in a class of medications called incretin mimetics, as it is a glucagon-like peptide-1 receptor agonist (GLP-1 agonist) consisting of GLP-1(7-37) covalently linked to an Fc fragment of human IgG4. GLP-1 is a hormone that is involved in normalizing the level of glucose in blood (glycemia). It works by aiding the pancreas to release the correct amount of insulin when blood sugar levels are high. Insulin helps to move sugar from the blood onto other body tissues where it's used for energy. Dulaglutide medication also slows the emptying of the stomach and may decrease appetite and cause weight loss.
The Food and Drug Administration (FDA) approved dulaglutide for use in the United States in September 2014. It was approved for use in the European Union in November 2014. In 2023, it was the 63rd most commonly prescribed medication in the United States, with more than 10 million prescriptions.
Source: English Wikipedia, "Dulaglutide".
Mechanism of Action
Dulaglutide binds to glucagon-like peptide 1 receptors, slowing gastric emptying and increasing insulin secretion by pancreatic Beta cells. Simultaneously the compound reduces the elevated glucagon secretion by inhibiting alpha cells of the pancreas, as glucagon is known to be inappropriately elevated in diabetic patients. GLP-1 is normally secreted by L cells of the gastrointestinal mucosa in response to a meal.
^ Nadkarni P, Chepurny OG, Holz GG (2014). "Regulation of glucose homeostasis by GLP-1". Progress in Molecular Biology and Translational Science. 121: 23–65. doi:10.1016/B978-0-12-800101-1.00002-8. ISBN 978-0-12-800101-1. PMC 4159612. PMID 24373234.{{cite journal}}: CS1 maint: periodical has ISBN (link)
What the Evidence Shows
The most common side effects include gastrointestinal disorders, such as dyspepsia, decreased appetite, nausea, vomiting, abdominal pain, diarrhea. Over the course of a 52-week double-blind study to detect the efficacy and safety of dulaglutide monotherapy versus metformin in type 2 diabetes, the most common side effects seen were nausea, diarrhea, and vomiting [20]. Some patients may experience serious adverse reactions: acute pancreatitis (symptoms include persistent severe abdominal pain, sometimes radiating to the back and accompanied by vomiting), hypoglycemia, renal impairment (which may sometimes require hemodialysis). The risk of hypoglycemia is increased if the drug is used in combination with sulfonylureas or insulin.
Some more serious side effects include: Ongoing pain that begins in the upper left or middle of the stomach but may spread to the back Vomiting Hives, rash, itching Difficulty breathing or swallowing Swelling of lips, tongue, face, or throat Vision changes Fast heartbeat Dizziness or fainting Pain in the upper stomach, fever, yellowing of skin or eyes, or clay-colored stools Other reported adverse effects of dulaglutide include a small mean increase in heart rate, small decrease in systolic blood pressure and increases in pancreatic enzymes. There is also a potential risk of medullary thyroid carcinoma associated with the use of the drug.
^ Nauck M, Weinstock RS, Umpierrez GE, Guerci B, Skrivanek Z, Milicevic Z (August 2014). "Efficacy and safety of dulaglutide versus sitagliptin after 52 weeks in type 2 diabetes in a randomized controlled trial (AWARD-5)". Diabetes Care. 37 (8): 2149–2158. doi:10.2337/dc13-2761. PMC 4113177. PMID 24742660.
^ Amblee A (April 2014). "Dulaglutide for the treatment of type 2 diabetes". Drugs of Today. 50 (4): 277–289. doi:10.1358/dot.2014.50.4.2132740. PMID 24918645.
^ Monami M, Dicembrini I, Nardini C, Fiordelli I, Mannucci E (February 2014). "Glucagon-like peptide-1 receptor agonists and pancreatitis: a meta-analysis of randomized clinical trials". Diabetes Research and Clinical Practice. 103 (2): 269–275. doi:10.1016/j.diabres.2014.01.010. PMID 24485345. S2CID 33922845.